Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients

Abstract

Recent developments should have aided to reduce postoperative complications of endoscopic sinonasal surgery: Computerised tomography (CT) and magnetic resonance imaging (MRI) allow a more precise preoperative view of the anatomic situation and possible variations. The Lund-MacKay-Index provides a tool to assess the extent of the disease, and by introducing microscopic-endonasal and computer-assisted sinunasal surgery (CAS) as well as providing the corresponding training technical progress has been made. We analysed the data of 2,596 patients with acute or chronic rhinosinusitis who underwent surgery between 2000 and 2005 using the procedure of Stammberger. We saw 3.1 % minor complications (minor bleedings, perforation of the lamina papyracea), 0.9 % major complications (severe bleedings, cerebrospinal fluid (CSF) leaks, lesion of the ductus lacrimalis), and one (0.04 %) serious complication (meningitis). When we compared these figures with those of reports from the late 90 s by correlating opacification, type of operation, the surgeon's experience and employing CAS with the outcome we did not find a distinct improvement in the rate of postoperative complications. Serious complications and those resulting in permanent harm such as carotid artery injury, cerebral deficit or death have, however, become very rare. A grading into I (minor), II (major) and III (serious) complications is proposed, to point out this critical grade-III proportion, which should not exceed 0.1 %.

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

“…Minor complications have been noted to occur in less than 4% of cases, with major complications occurring in approximately 1%. 1,2 Surgical field visualization is essential for successful outcomes from this procedure and to minimize development of these complications. Bleeding in the surgical field can be progressive and even detrimental, causing prolonged operative time, incomplete surgical interventions, and increased complications due to difficulty visualizing and identifying landmarks with subsequent injury of important anatomical structures.…”

Fulminant Meningitis after Radiotherapy for Clival Chordoma

“…CSF fistulas and meningitis are serious complications associated with TSS [7]. However, our patient did not present with a postoperative CSF fistula because the tumor was located in the extradural space and surgery was performed without injuring the dura.…”

Fehler und Gefahren: Eingriffe an den Nasennebenhöhlen und der Frontobasis unter Berücksichtigung mediko-legaler Aspekte

“…Der Häufung von Duraverletzungen bei Anfängern wurde von anderer Seite jedoch widersprochen [ 196 ] ; andere Autoren sehen nur vermehrt postoperative Synechien oder Narbenstenosen im Stirnhöhlenzugang [ 632 ] . Relevante Blutungen traten ohne Bezug zur Erfahrung des Operateurs auf [ 39 ] -wobei erfahrene Operateure allerdings vermehrt umfängliche Eingriff e vornehmen [ 75 ] . In der Folge werden insbesondere dramatische Komplikationen und Komplikationen mit mediko-legalen Folgen bei Erfahrenen vermehrt beobachtet [ 82 , 94 , 633 ] .…”